[From waiting to pro-active health care. The main road to build the second pillar of health system].

The waiting paradigm is typical of acute diseases: one waits for an event upon which to act, a problem to solve. Waiting is the classical health care paradigm of the bio-medical model, upon which has always been based the university training. It is not astonishing that it also became the dominant paradigm in the territorial and primary care. Pro-active health care is the best fitted to manage primary care in general and chronic diseases in particular (including mental illnesses and drug addictions), where the support is mainly extensive and characterized by a long term case-management. Here, the added value of the health care processes is in the ability to preserve the continuity of care and in the quality of the relationship, the trust, between the system and its clients, the service providers and the service users. An overview of international experiences.